Abstract: The multiple-choice question (MCQ) is the most commonly used type of test item in radiologic graduate medical and continuing medical education examinations. Now that radiologists are participating in the maintenance of certification process, there is an increased need for self-assessment modules that include MCQs and persons with test item-writing skills to develop such modules. Although principles of effective test item writing have been documented, violations of these principles are common in medical education. Guidelines for test construction are related to development of educational objectives, defining levels of learning for each objective, and writing effective MCQs that test that learning. Educational objectives should be written in observable, behavioral terms that allow for an accurate assessment of whether the learner has achieved the objectives. Learning occurs at many levels, from simple recall to problem solving. The educational objectives and the MCQs that accompany them should target all levels of learning appropriate for the given content. Characteristics of effective MCQs can be described in terms of the overall item, the stem, and the options. Flawed MCQs interfere with accurate and meaningful interpretation of test scores and negatively affect student pass ra! tes. Therefore, to develop reliable and valid tests, items must be constructed that are free of such flaws. The article provides an overview of established guidelines for writing effective MCQs, a discussion of writing appropriate educational objectives and MCQs that match those objectives, and a brief review of item analysis.